Positive Behavioural Management (PBM) Trainer
Steve is a Positive Behavioural Management (PBM) Trainer and his role involves supporting staff teams to develop their understanding and response to people with behaviours which challenge the service. This includes people with mental health issues, young people and people with a learning disability.
It is within this role that Steve was introduced to a staff team who support 2 women Jane and Vicky in their home. It is Vicky that we will focus on. Vicky is diagnosed on the autistic spectrum and communicates non-verbally; her behaviours are extremely challenging to those who support her, with daily expressions of aggression and violence. The team have worked alongside Vicky for many years and prior to their PBM training, saw her behaviours as "just what she does!"
It was felt that by offering PBM training to Vicky’s whole staff team that this would enable them to understand that her behaviour as a means of communication and to start to ask themselves the question "is there an unmet need here for Vicky ?". Steve wanted to support the team to start to see Vicky’s behaviours differently and as her way to tell the team that she was very anxious.
Each morning Vicky would wake, leave her bedroom, with her hands extended into a claw and would attempt to scratch the face of the first person she saw.
The team were encouraged to think about what it was that made Vicky behave in this way…what did they know about Vicky?, what could be the triggers behind her behaviour? For example, was it learnt behaviour that had become routine over a prolonged period of time? What was she communicating to others around her? Were there any specific members of staff that was a trigger? Was she in distress and/ or pain? Was there an unmet need in terms of Vicky’s communication and her observable high levels of anxiety?
The team were encouraged by Steve and the local manager to think about Vicky’s situation in a different way, in particular thinking about Vicky’s communication of her anxiety. Steve reassured staff that minimising Vicky’s anxiety would require a process of elimination, using different techniques and thinking outside of the box to support Vicky. People change over time and their support needs change. What may have worked well a year ago, may not work as well now; indeed support that is provided on an on-going basis needs to regularly monitored and reviewed to provide opportunities to critique that support and learn from it. Furthermore, the importance of consistency of support, which makes sense to a person supported and enhances the quality of their lives, remains a key focus for Vicky’s team.
Providing staff with three days of PBM training created a supportive learning environment, which enabled them to think creatively about Vicky’s anxieties and why Vicky was anxious at different times and especially in the mornings.
As a result of this invaluable thinking time together, Vicky’s team decided to develop a photographic staff rota up on Vicky’s bedroom wall, clearly displaying which staff were going to be supporting her in the morning. Whilst the training was (and is) not intended as a ‘quick fix’ the staff have still been kept on their toes whilst supporting Vicky and changing in the way they support her. They have been supported to change, quite significantly, in the way they understanding communication; in particular, exploring challenging behaviours in the context of what the person is communicating to their support staff, through their behaviours.